title: Age-related disparities in use of completion lymphadenectomy for melanoma sentinel lymph node metastasis.
abstract: BACKGROUND
  Guidelines recommend that patients with melanoma metastatic to the sentinel lymph node (SLN) undergo a completion lymphadenectomy (CLND) of the affected lymph node basin. We have previously reported on decreased use of SLN biopsy among elderly patients. We hypothesized that elderly patients with SLN metastases would have lower rates of CLND relative to their younger counterparts.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database was queried for patients who underwent SLN biopsy for intermediate thickness cutaneous melanoma (Breslow thickness 1.01 mm-4.00 mm) from 2004 to 2008 and were found to have SLN metastasis. Patients were categorized according to age by decade. We then used multivariate logistic regression models to predict receipt of CLND. Additional covariates included sex, race/ethnicity, T stage, tumor histology, tumor location, and ulceration. The likelihood of receiving a CLND was reported as OR with 95% CI; significance was set at P ≤ 0.05.
  
  
  RESULTS
  Entry criteria were met by 765 patients. Of these, 548 (71.6%) patients underwent CLND. On multivariate analysis, patients in the age groups 70-79 y old (OR 0.39, CI 0.20-0.78; P = 0.007) and ≥ 80 y old (OR 0.27, CI 0.12-0.61; P = 0.001) were less likely to undergo CLND than the youngest age group (1-39 y old).
  
  
  CONCLUSIONS
  Elderly patients with SLN metastasis are less likely to receive CLND than their younger counterparts. A multi-center randomized clinical trial evaluating the potential survival benefit of CLND is ongoing. Further research to assess reasons why the elderly are less likely to receive CLND are needed.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of California at Davis, Sacramento, California.
authors.forename: Dhruvil R
authors.initials: DR
authors.lastname: Shah
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Yang
authors.forename: Emanual
authors.initials: E
authors.lastname: Maverakis
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D018426:SEER Program / Q000706:statistics & numerical data; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D055815:Young Adult
keywords: Age; Completion lymphadenectomy; Disparities; Melanoma; Sentinel lymph node